Elevated INR: Factor treatment
Clinical - Hematologic
1. Prothrombin complex concentrate
Prothrombin Complex Concentrate (PCC) (trade name Octaplex or Ocplex) is a combination of blood clotting factors II, VII, IX and X, as well as protein C and S. It reverses the effect of warfarin (a coumarin anti-coagulant) and is used in cases of significant bleeding in patients with a coagulopathy (INR > 8.0, prolonged prothrombin time, raised d-dimer). Examples include gastrointestinal haemorrhage or intracranial haemorrhage.
PCC is effective but expensive.
2. FFP: 10-15ml/kg
3. Always give the vitamin K with the plasma because the effect of plasma is only transient and the patient may have a rebound rise in the INR if vitamin K is not given